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Mahran A, Abdelmeged A, Shawki H, Moheyelden A, Ahmed A M. Nitric oxide donors improve the ovulation and pregnancy rates in anovulatory women with polycystic ovary syndrome treated with clomiphene citrate: A RCT. IJRM 2016; 14 (1) :9-14
URL: http://ijrm.ir/article-1-692-en.html
1- Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt , ezzeldin_ahmad@yahoo.com
2- Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Minia, Egypt
3- Department of Obstetrics and Gynecology, Beni-Mazar General hospital, Minia, Egypt
Abstract:   (2695 Views)
Background: Clomiphene citrate (CC) is the first line agent used for ovulation induction in patients with polycystic ovarian syndrome (PCOS). However, there is marked discrepancy between the ovulation and pregnancy rates achieved, which may be attributed to the undesirable effect of CC on cervical mucus and endometrium.
Objective: The aim of this study was to evaluate the effect of Isosorbid monoitrate (ISMN) as nitric oxide (NO) donors on the ovulation and pregnancy rates in an ovulatory women with PCOS treated with CC.
Materials and Methods: Ninety patients with PCOS were randomly allocated into three groups. Patients in group A) were treated with 100 mg CC for five days starting from the fifth day of the cycle. Patients in group B) and C) received 10 mg and 20 mg of ISMN respectively in addition to CC, applied vaginally till the diagnosis of ovulation.
Results: There was a significant increase in the ovulation and pregnancy rates in the patients treated with CC+ISMN as compared with patients treated with CC alone (p< 0.001).
Conclusion: Concomitant use of NO with CC seems to improve the ovulation and pregnancy rates in the patients with PCOS with no significant increase in side effects as compared with CC alone.
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Type of Study: Original Article |

References
1. Thessaloniki ESHRE/ASRM-Sponsered PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod 2008; 23: 462-477. [DOI:10.1093/humrep/dem426]
2. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endorcinol Metab 2004; 89: 2745-2749. [DOI:10.1210/jc.2003-032046]
3. De Pace V, Chiossi G, Facchinetti F. Clinical use of nitric oxide donors and L-arginine in obstetrics. J Matern Fetal Neonat Med 2007; 20: 569-579. [DOI:10.1080/14767050701419458]
4. Tsukimori K, Komatsu H, Fukushima K, Kaku T, Nakano H, Wake N. Inhibition of nitric oxide synthetase at mid-gestation in rats is associated with increases in arterial pressure, serum tumour necrosis factor-alpha, and placental apoptosis. Am J Hypertens 2008; 21: 477-481. [DOI:10.1038/ajh.2007.80]
5. Agarwal A, Gupta S, Sharma Y. Role of oxidative stress in female reproduction. Reprod Biol Endocrin 2005; 3: 28. [DOI:10.1186/1477-7827-3-28]
6. Zhang X, Lin HY, Liu GY, Wang HM, Li QL, Zhu C. Expressions and regulation of endothelial and inducible nitric oxide synthases in mouse uterus during the estrous cycle and early pregnancy. Front Biosci 2005; 10: 3172-3182. [DOI:10.2741/1773]
7. The Rptterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19: 41-47. [DOI:10.1093/humrep/deh098]
8. Insler V, Melmed H, Eichenbrenner I, Serr D, Lunfeld B. The cervical score. Obstet Gynaecol 1972; 32: 620-625. [DOI:10.1002/j.1879-3479.1972.tb00857.x]
9. Franks S, Stark J, Hardy K. Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 2008; 14: 367-378. [DOI:10.1093/humupd/dmn015]
10. Homburg R. Clomiphene citrate-end of an era? A mini-review. Hum Reprod 2005; 20: 2043-2051. [DOI:10.1093/humrep/dei042]
11. Hammond MG, Halme JK, Talbert LM. Factors affecting the pregnancy rate in clomiphene citrate induction of ovulation. Obstet Gynecol 1983; 62: 196-202.
12. Eijkemans MJ, Imani B, Mulders AG, Habbema JD, Fauser BC. High singleton live birth rate following classical ovulation induction in normogonadotrophic anovulatory infertility (WHO 2). Hum Reprod 2003; 18: 2357-2362. [DOI:10.1093/humrep/deg459]
13. Thompson LA, Barratt CL, Thornton SJ, Bolton AE, Cooke ID. The effects of clomiphene citrate and cyclofenil on cervical mucus volume and receptivity over the periovulatory period. Fertil Steril 1993; 59: 125-129. [DOI:10.1016/S0015-0282(16)55627-1]
14. Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update 1997; 3: 359-365. [DOI:10.1093/humupd/3.4.359]
15. Palomba S, Orio F J, Falbo A, Manguso F, Russo T, Cascella T, et al. Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005; 90: 4068-4074. [DOI:10.1210/jc.2005-0110]
16. Artini PG, Battaglia C, D'Ambrogio G, Barreca A, Droghini F, Volpe A, et al. Relationship between human oocyte maturity, fertilization and follicular fluid growth factors. Hum Reprod 1994; 9: 902-906. [DOI:10.1093/oxfordjournals.humrep.a138614]
17. Anteby EY, Hurwitz A, Korach O, Revel A, Simon A, Finci-Yeheskel Z, et al. Human follicular nitric oxide pathway: relationship to follicular size, oestradiol concentrations and ovarian blood flow. Hum Reprod 1996; 11: 1947-1951. [DOI:10.1093/oxfordjournals.humrep.a019522]
18. Tao M, Kodama H, Kagabu S, Fukuda J, Murata M, Shimizu Y, et al. Possible contribution of follicular interleukin-1ß to nitric oxide generation in human preovulatory follicles. Hum Reprod 1997; 12: 2220-2225. [DOI:10.1093/humrep/12.10.2220]
19. Bassil S, Wyns C, Toussaint-Demylle D, Nisolle M, Gordts S, Donnez J. The relationship between ovarian vascularity and the duration of stimulation in invitro fertilization. Hum Reprod 1997; 12: 1240-1245. [DOI:10.1093/humrep/12.6.1240]
20. Tschugguel W, Schneeberger C, Unfried G, Bräutigam G, Wieser F, Czenwenka K, et al. The role of nitric oxide in reproduction. Gynakol Geburtshilfliche Rundsch 1998; 38: 44-46. [DOI:10.1159/000022226]
21. Cameron IT, Campbell S. Nitric oxide in the endometrium. Hum Reprod Update 1998; 4: 565-569. [DOI:10.1093/humupd/4.5.565]
22. Zaidi J, Jacobs H, Campbell S, Tan SL. Blood flow changes in ovarian and uterine arteries in women with polycystic ovary syndrome who respond to clomiphene citrate: correlation with serum hormone concentrations. Ultrasound Obstet Gynecol 1998; 12: 188-196. [DOI:10.1046/j.1469-0705.1998.12030188.x]
23. Battaglia C, Salvatori M, Maxia N, Petraglia F, Facchinetti F, Volpe A. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients. Hum Reprod 1999; 14: 1690-1697. [DOI:10.1093/humrep/14.7.1690]
24. Balen AH, Laven JS, Tan SL, Dewailly D. The ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003; 9: 505-514. [DOI:10.1093/humupd/dmg044]
25. Morlin B, Hammarstrom M. Nitric oxide increases endocervical secretion at the ovulatory phase in the female. Acta Obstet Gynecol Scand 2005; 84: 833-836. [DOI:10.1111/j.0001-6349.2005.00752.x]
26. El-berry S, Razik MA. Nitric oxide donors increases pregnancy rate in clomiphene citrate treated polycystic ovary infertile patients. Middle East Fertil Soc J 2010; 15: 106-109. [DOI:10.1016/j.mefs.2010.04.004]
27. Ajam KA, Farzadi L, Nouri M, Sadagheani MM. The effect of nitric oxide with minimal stimulation on patients with polycystic ovarian syndrome. Int J Women's Health Reproductive Sci 2014; 2: 121-131. [DOI:10.15296/ijwhr.2014.19]

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